Elderly – person in the age group 65-75 years old

Old - persons beyond the age of 75

Aged – term used to cover both elderly and old.

Senescence - process of growing old or the period of aging

Geriatrics – branch of medicine concerned with prolonging life, delaying the onset of degenerative aspects of aging and treating the disease of aged.

Gerontology – broader branch of science dealing psychological, sociological, economic, physiological and medical aspect of aging.

Theoretically aging begins at conception and ends in death. The characteristics of aging however differ at various stages of the life cycle. During the period of growth, the anabolic or building up processes exceeds the catabolic or degenerative changes so that the net result is one of growth and increased functional capabilities of the organs and tissues of the body. Upon physiologic maturity, the process is reversed. Anabolism starts to exceed catabolism, although the rate of reversal is slow. This results to slowing down of functional capabilities. During senescence, catabolism greatly exceeds anabolism which results to impaired functioning of many organs of the body.

Decrease in the efficiency of the organs caused by loss of cells and decreased functioning level of the remaining cellsDecrease in the number and functional capabilities of the cells resulting to decreased ability of the cells to synthesized needed enzymes, decreased ability to synthesize and break down protein and also a decreased ability to use energy because of the decreased in number of mitochondria.

There are structural changes associated with collagen. Collagen is the non cellular protein substance that binds the cells together. Among the aged, their collagen is less elastic and more fibrous. It is believed that the collagen replaces some of the active cells lost from degenerating organs. Also, the muscle fibers of the muscle tissues maybe replaced by collagen which gives the wrinkled appearance of the skin.

The process of aging proceeds at different rates in different individuals. It is also affected by several factors such as biological and environmental influences. It also depends on exposure to life stresses. To date, there are no conclusive evidences yet which could fully explain the process of aging. Generally though, the changes are irreversible.

Since aging starts at conception, the best preparation for a healthy old age starts at conception. Observing proper nutritional habits and also of a healthy lifestyle should be a decorum at all stages of the life cycle. The nutritional needs of the elderly persons are basically the same as those of a younger individual with only minor modification.

Energy.

The demand for calories is decreased because of decreased basal metabolism and decreased physical activities. The average change in caloric allowance are as follows;

Age group Change in caloric allowance (compared to adult RDA 20 to 39 years)

50-59 years decreased by 10%60-69 years decreased by 20 %>70 years decreased by 25%

Since calorie requirement is reduced, carbohydrate and fat sources must be chosen with considerable care. Carbohydrate should be in the form of starches or complex forms rather than refined carbohydrate. Fat must be mainly composed of polyunsaturated fatty acid. Such recommendation is made because of the relationship of the form of carbohydrate and saturated fatty acid with the occurrence of coronary heart disease.

Protein

Protein is necessary for the prevention of progressive tissue wasting and susceptibility to disease and infection. The allowance of 1.1 gram per kilogram DBW is still applicable to this age group. However, the aged who have had poor dietary habits or is ill, will benefit from an increased protein intake.

Vitamins and Minerals.

Special emphasis must be placed on the adequacy of calcium, iron and ascorbic acid. Researches have shown that an increased calcium intake will relieve the symptoms of osteoporosis. Vitamin C will facilitate absorption of calcium and iron.

Water and Fiber.

About 6-8 glasses of fluid should be consumed to enable the kidneys to efficiently eliminate waste solids. Also, water stimulates peristalsis thus preventing constipation. Fiber also encourages peristalsis but rough fiber is not recommended. The aged must be given tender fruits and vegetables.

The aged enter this period with set dietary habits which have been acquired in their entire lifetime. If they have had good food habits, they’ll have less nutritional problems. However, having undesirable food habits will pose a big problem. Furthermore, there are many factors that affect adequate feeding of the elderly such physical, physiological, psychological and economic considerations.

Biological Change Nutritional implications

Atrophy of salivary gland May cause of difficulty in swallowing especially of dry foods.

Loss of taste buds May make eating less pleasurable. Many elderly people use increased amounts of seasoning because food is tasteless otherwise

Loss of teeth Although not inevitable, very common with aging. Diet need not suffer if properly fitted dentures are worn. However, if the necessary dental treatment cannot or will not be obtained, the diet may be limited to soft foods that do not require chewing. Such diets are commonly inadequate unless the person knows about nutrition that most people do.

Decreased Secretion of stomach acid

Common but far from universal in old age. Certain minerals are absorbed less efficiently when stomach acid secretion declines.

Decreased SecretionOf intrinsic factor

Magnitude of decrease so small to significantly impair B12 absorption in most elderly people.

Decline in Basal Metabolic Rate

It is common for the elderly to feel cold at temperatures comfortable to younger people. Energy needs also decrease.

Decreased size andActivity of thyroid gland

Probably a response to decrease need for thyroxin to regulate metabolism of lean body mass.

Increased proportion of Fat to Lean

Universal in aging as dying cells are progressively replaced with fat cells rather than with the type of cell that died.

Decreased Physical Activity

This results from impaired coordination, decreased speed and strength neuromuscular reactions. However, the basis may also be social and psychological: retirement from work, lack of opportunities for previously enjoyed group activities and loss of companions with whom activities were formerly shared can lead to a sedentary lifestyle.

Loss of NeuromuscularCoordination

The ability to maintain fine neuromuscular Coordination declines with the aging process. This poses a problem among the aged because they will have a harder time in manipulating eating utensils. Thus, rather that take the risk of embarrassment, that would come with spilled food or inability to cut meat, they will just avoid eating foods which they find hard to manage.

Onset of many Degenerative Diseasessuch as Cardiovascular diseases, diabetes, osteoporosisand arthritis

Disease can impair the digestion, absorption and metabolism of nutrient. Drugs necessary to treat the disease may have further adverse effects on nutrient utilization. Presence of degenerative diseases calls for modification of diet and change of lifestyle.

Aside from biological changes that accompany aging which affects his nutrient intake, certain psychological and economic factors also pose nutritional problems for the aged.

Boredom, inactivity and routine of the aged tend to encourage a monotonous diet which often leads to deficiency symptoms. The aged undergoes various emotional stresses associated with his increasing insecurity as he advances old age. Anxiety, depression and suspicion are commonly felt by the aged which impairs their ability to properly utilize ingested nutrients.

Decreased functional capabilities lead to decreased productive capacity which will likely affect the aged’s financial status. Thus, the aged, especially those coming from poor families, tend to compensate for decreased income by decreasing the quantity and quality of their food choices. Therefore, the dietary management of the elderly should not only keep him physically alive but also socially and psychologically young.

Difficulty in chewing due to loss of teeth and poor dentures Meat, fish and vegetables can be sliced or chopped into small bite-sized pieces for easy chewing.

Lack of appetite Use of appetizers such as light soups will stimulate

better appetite. Finger foods have been found to be well liked by the aged because it requires less effort and easier to handle. It is also better to serve familiar foods served attractively by varying the color, shape and size can make meals enjoyable. Light exercise like walking and gardening can improve appetite and keep body fit.

Poor Digestion leading to constipation, gas pains or diarrhea

Inclusion of fruits and vegetables in the daily meals will prevent constipation. For those with sensitive digestive system, something hot at each meal will be beneficial. Frequent but smaller meals are often more acceptable than three big meals. The heaviest meal should be eaten during lunch rather than supper. Fats may retard digestion so fatty meat and desserts containing coconut milk should be avoided.

Poor absorption leading to anemia and other vitamin deficiencies.

Anemia can be prevented by eating iron rich foods like liver, lean meat, egg yolk and other green leafy vegetables, Vitamin C rich foods will also help absorb iron. Enough sunshine and foods like milk, cheese and other milk products, dilis, alamang and leafy vegetables contain calcium needed for strong bones.

Unwanted weight due to lack of physical activity and/or overeating.

It is recommended to take only moderate amount of energy foods. Eat only the lean part of the fish and meat. The fatty portion should be avoided.

Anxiety, confusion, insecurity an lonelinessGive the aged something to do. Let him feel

useful. Encourage the aged to have social life by having a hobby or joining a club.